Finding an Rx for Escalating Pharmacy Costs by Carving Out Benefits

Prescription drug spending is one of the most complex and fastest-growing aspects of the self-insured healthcare benefits plan, and it is essential that employer pharmacy benefits receive the same due diligence as medical benefits. However, for employers who have carved-in pharmacy benefits, the need to examine pharmacy costs and utilization is intensified.

In a carved-in arrangement, the same insurance carrier providing the medical benefit also holds the pharmacy contract with the Pharmacy Benefit Manager (PBM), meaning there is not a sole focus on pharmacy. As a result, carved-in plans face challenges around their lack of choice and control, limited visibility into contract terms, and ineffective reporting and analytics on their prescription drug trend.

By switching to a carved-out pharmacy benefit arrangement, employers can gain much-need control over their prescription drug spending and lower their overall benefits costs. See how we helped a growing municipality do exactly that.